Most early prostate cancers are detected with PSA tests or digital rectal exams before they cause any symptoms. However, more advanced prostate cancers can cause a variety of symptoms including:

• trouble starting urination
• urinating much more frequently than usual
• the feeling that you can't release all of your urine
• pain on urination or ejaculation
• blood in your urine or semen
• impotence
• bone pain

All of these symptoms can be caused by a variety of things besides prostate cancer, so experiencing them doesn't necessarily mean you have prostate cancer. When older men have problems urinating, it is usually caused by process called benign prostatic hyperplasia (BPH) which is not prostate cancer. If you experience any of these symptoms, you need to see your doctor for evaluation.

Several methods are used to find prostate cancer.  It is important to understand the limitations of each.   On physical examination the doctor places a gloved finder into the rectum.  This is called a digital rectal exam (DRE).  It is important to realize that this exam only enables the doctor to touch the back part of the prostate gland.  The front part of the prostate is not in an area that can be touched.  Therefore, if you are told by your doctor that the prostate feels normal, this is only means that the back surface feels normal.  Cancer can grow anywhere, in the front and/or the inside, where the doctor cannot feel the tumor.  The other thing to remember is that if a tumor can be felt, that means it has been present for some time.  This means that it might have already grown into the area of blood vessels.  This means that doctors need another way to check for cancer.  Recent advances in medicine, have made this possible.  A blood test called a PSA can be helpful in finding cancer in the prostate.

If you have symptoms suspicious for prostate cancer, your doctor will do a digital rectal exam and a PSA blood test. If either of those two test are abnormal, then most likely your doctor will recommend that you receive a biopsy. Also, your doctor may want to get a biopsy if there is an abnormal result on a screening PSA or digital rectal exam. A biopsy is the only way to know for sure if you have cancer, because it allows your doctors to get cells that can be examined under a microscope. The most common way that a biopsy is done is with a transrectal ultrasound (TRUS). A transrectal ultrasound is a thin cylinder that emits sound waves and monitors them when they bounce off of tissue. It is inserted into your rectum, and allows your doctor to view your prostate and choose where to remove tissue from. Any suspicious areas are biopsied, plus some tissue will be removed from all of the different parts of the prostate (to make sure they don't miss any cancers that may be small and growing in one particular area). The procedure is done while you are awake, with the help of some numbing medicine. Unfortunately, a transrectal ultrasound isn't a perfect tool because even though many samples are taken, it can occasionally miss the area of the cancer. If this happens, and your PSA remains elevated, you will probably need to have the procedure repeated in a few months.

Once the tissue is removed, a doctor known as a pathologist will review the specimen. The pathologist can tell if it is cancer or not; and if it is cancerous, then the pathologist will characterize it by what type of prostate cancer it is and how abnormal it looks (known as the grade). The vast majority of all prostate cancers (at least 95%) are a subtype known as adenocarcinoma, but occasionally they can be small cell carcinomas or lymphomas (two rare types of prostate cancer that are treated differently than the more standard adenocarcinomas). The pathologist then characterizes how much the cancer looks like normal prostate tissue, and this is known as the grade of the tumor. Pathologists often use a scale when they grade prostate tumors known as the Gleason score. The Gleason score runs from 2 to 10, with 2 being a very normal looking tumor and 10 being a very abnormal looking tumor. Generally, the more abnormal the tumor looks, the more aggressive it is. We characterize grades on a scale because, together with staging, it gives us a way to offer a prognosis and it often guides our choice of therapy.

If cancer is found in the prostate, the doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The doctor may use various blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these findings.

Prostate cancer staging is a complex process. The doctor may describe the stage using a Roman number (I-IV) or a capital letter (A-D). These are the main features of each stage:

• Stage I or Stage A The cancer cannot be felt during a rectal exam. It may be found by accident when surgery is done for another reason, usually for BPH. There is no evidence that the cancer has spread outside the prostate.
• Stage II or Stage B The tumor involves more tissue within the prostate, it can be felt during a rectal exam, or it is found with a biopsy that is done because of a high PSA level. There is no evidence that the cancer has spread outside the prostate.
• Stage III or Stage C The cancer has spread outside the prostate to nearby tissues.
• Stage IV or Stage D The cancer has spread to lymph nodes or to other parts of the body.
  
  

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  Date of Last Update: 11/27/06